A Rare But Potentially Life-Threatening Condition

It's an odd thing that legislation would result in the input to one sensory organ directly contradicting that of another. But it's a funny world we live in, and this is the situation we get with direct-to-consumer broadcast advertising of prescription drugs. If you live in the United States, you've been there: while a scene unfolds before your eyes in which people are doing all the things that you normally think of as constituting a happy and fulfilled life, a narrator is reminding you that the product advertised "can cause serious and sometimes fatal bleeding" or "may lead to increased depression and thoughts of suicide." When the input to your visual cortex is contradicted by the input to your auditory cortex and Wernicke's area, who wins?

Readers outside the US who have not experienced this form of sensory stimulation may want to try an experiment. First, watch this commercial without the sound and try to figure out what its message is:

For the first twenty seconds of the commercial, solitary and morose people fret, flop about, or snooze in a dark interior world of subdued colors. After this we learn the name of the product, Cymbalta, and at 27 seconds we see a graphic of an amorphous blue-green substance oozing out from the spinal column of a stylized figure. Thereafter, the curtains open, the sunshine comes in, and everyone gets happy, active, lighter, and extremely social — even the dog in the commercial, who was all alone to begin with. Without the audio portion of the commercial, you would conclude that Cymbalta is definitely a happy pill, and you might want to take it.

The soundtrack of the commercial confirms most of the points you get in the video part with one important difference: when the people get all happy, the narrator gets all serious about the possible side effects of the drug. This is the point where the sensory integration function of our brains seems to be needlessly taxed: it's a challenge to process information about liver disease when the deadpan description of it that you hear is accompanied by smiling kids with ice cream cones. Or to put it another way, when a soundtrack is talking about "risk of coma or death," it would be a lot less startling to see a patient on a drip being rushed down a hospital corridor on a gurney than to see a happy and attractive young couple strolling quietly under colorful party lanterns, as you see in this commercial:

The legislation that results in this peculiar experience being available to US television viewers is broadly the Federal Food, Drug and Cosmetic Act, and more narrowly, Title 21 of Federal Regulations and a Guidance for Industry issued by the FDA and the Department of Health and Human Services in 1999. All of these documents spell out in great detail the prohibitions on various practices that a profit-seeking corporation might be tempted to engage in, but guidance about the exposition of major risks posed by these drugs is not very specific: it must be presented "either the audio or audio and visual parts of the presentation." Folks were aware that a picture is worth a thousand words long before these regulations were formulated, and drug manufacturers seem to have chosen the course that will showcase the benefits of their products visually, while a simultaneous audible portion presents the cautions. Some commercials present some of the risks with text visible on the screen, like this commercial — also highly recommended for a first viewing without the sound — for Lunesta, a prescription sleeping pill:

The most startling possible side-effects of this drug — somnambulism, aggressiveness, agitation, hallucinations or confusion — are confined to the narration between seconds 20 and 50 of the commercial, while a luminescent lepidopteran pays calls on various troubled sleepers and attaches itself briefly to their backsides. It's a very artful commercial that takes an expressionist approach combined with elements of vampirism to explain the effect of the drug. But it would surely be more entertaining, and probably much closer to the idea of truth in advertising, to see some of the side-effects re-enacted in these commercials, rather than being confined to the narration; in other words, to see the "show" and "tell" portions of the commercial switched.

Does this sort of advertising work? A report by the Kaiser Family Foundation found that consumers are very responsive to the intent of this kind of advertising, and that a significant number do in fact act as prompted by the concluding suggestion in many of the commercials: "Ask your doctor if ______________ is right for you." The report says that "nearly a third of adults say they have talked to their doctor about a drug they saw advertised, and 44% of those who talked to their doctor received a prescription for the medication they asked about. This means that 13% of Americans have received a specific prescription in response to seeing a drug ad." The study concluded that for the period examined, each additional dollar that the pharmaceutical industry spent on direct-to-consumer advertising yielded $4.20 in additional pharmaceutical sales in that year.

The US is the only country besides New Zealand that allows this sort of advertising of prescription drugs; it would be interesting to hear from readers there whether the commercials are in a similar vein. It's an interesting feature of the use and subordination of language in a consumer economy, and it is in some ways the other side of the coin to a different kind of drug-related advertising that is very common in the United States but widely prohibited elsewhere: what we might call the ambulance chaser commercial, in which law firms try to attract the business of people who think they may have suffered ill side-effects from prescription drugs. These are a completely different genre of commercial, with rather low-budget production values, no live action, no hired talent, little or no music, and large, comic-book style graphics:

The virtue of this sort of commercial, if it has one, may be that the video and audio portions of it present a completely unified message.